Basic Information
| Provider Information | |||||||||
| NPI: | 1902848625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT WOOD JOHNSON MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 EXECUTIVE DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323695965 | ||||||||
| FaxNumber: | 7323695993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ROBERT WOOD JOHNSON PL | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357840 | ||||||||
| FaxNumber: | 7322357048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | BERSHAD | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7329378897 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 5595676 | 01 | NJ | AETNA PPO GROUP # | OTHER | 0142345000 | 01 | NJ | AMERIHEALTH GROUP # EDISO | OTHER | 2078417 | 01 | NJ | AETNA HMO GROUP # | OTHER | 7172702 | 05 | NJ | MEDICAID | CJ3781 | 01 | NJ | RAILROAD MEDICARE GROUP # | OTHER | 0142345004 | 01 | NJ | AMERIHEALTH GROUP # MONRO | OTHER |